New Strategies for Healthcare in the Home and Community

1. New Strategies for Healthcare in the Home and Community Role of Nursing Leadership Judith Shamian, President and CEO, VON Canada Janice McCallum, Chair of the Board of Directors, VON Canada

2. What is Home & Community Care in Canada? What is Home & Community Care? • no single definition of home care –it encompasses a wide range of health services delivered at home and throughout the community to recovering, disabled, chronically or terminally ill persons in need of medical, nursing, social or therapeutic treatment and/or assistance with the essential activities of daily living.

3. Each Province, each Health Authority defines what is home and community care differently • Home and community care is not part of the Canada Health Act as a result there is no basic basket of care • At the last FMM Home Care was defined as 2 weeks post acute, end of life and mental health

4. Home Care in Canada Expenditure on home care (including services in support of informal care) as a percentage of their GDP*: • Sweden spends ……………….0.72% • Norway spends ……………… 0.59% • Germany spends ……….…………… 0.39% • United Kingdom spends …………… 0.29% • United States spends ………………. 0.16% • Canada spends ……………… 0.16% • Spain spends ……………………….. 0.06% *M. Huber, 2004

5. Changing Environment • Growing Numbers and Changing Needs of Persons Requiring Care • 1 million Canadians access home care annually • By 2026 the number of people over aged 65 expecting to double • Increased life expectancy • Increasing # of seniors with dementia • Increasing demand to be cared for at home • 38% dissatisfied with access to home care • 40% of individuals over 65 have a disability

6. Who provides care in the Community???? sources: *Canadian Home Care Human Resources Sector Study, 2003 ** National Population Health Survey, (NPHS), 1996 *** Statistics Canada, General Social Survey, 1996

7. VOLUNTEERS

8. Shifting Paradigms Caregivers in Canada Caregivers: • As more and more care is shifted from hospitals and institutions into the homes and communities of Canadians, the role of care provider is often left up to family members, relatives, friends or neighbours. • Today there are an estimated 3 million caregivers in Canada – who day in and day out provide care and support ranging from meal preparation and transportation to medicine administration and dressing changes. • Caregivers provide more than 2 billion hours of caregiving, saving the Canadian health care system about $5 billion each year.  

9. HOME AND COMMUNITY CARE IS A COMPLEX SECTOR, NOT ON THE POLICY RADAR SCREEN, AND LARGELY THE POOR RELATION TO THE ACUTE CARE SECTOR. • WHAT ROLE CAN NURSE EXECUTIVES PLAY TO CHANGE THE LANDSCAPE?

10. NURSE EXECUTIVE AS A GOVERNANCE VOLUNTEER AND NURSE EXECUTIVE AS A CEO

11. Nursing Leaders as Volunteers • Nursing leaders well placed to understand gaps and inconsistencies in community care • Nursing perspective important to health care system, and society as a whole • Much can be accomplished by volunteering time and knowledge as: • Members Boards of Director for key organizations • Members of roundtables, stakeholders groups • Members of citizen’s groups/civic organizations

12. Nursing Leader as Chair of the Board of Directors • The Lived Experience of Leadership as a Volunteer in the Community

13. LEADERSHIP

14. Nurse as CEO • Experience of setting and influencing the vision for the Organization • External influence as CEO of the largest, not-for-profit, charitable home care organization

15. Nurse as CEO • Influence in Policy Development • Roundtable participation • Lobbying policy makers • Active Participation in Research • National Survey • Providing leadership for under-represented groups • Caregivers • Volunteers • Patient Safety in the Home

16. IT IS A RACE: NURSE EXECUTIVES CAN MAKE A DIFFERENCE Positional Bargaining vs Interest-Based Bargaining